Anxiety leads to increased perception of pain during intravitreal injections
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Pre-procedure anxiety is the best predictor for perceived pain during intravitreal injections and may help to identify patients at risk for elevated pain, according to a poster presentation.
“Intravitreal anti-VEGF injections are the most commonly performed intraocular procedure worldwide. They are generally well tolerated, but some patients may experience pain, resulting in poor adherence to future treatment,” Matthew S. Wieder, MD, said at the virtual Association for Research in Vision and Ophthalmology meeting.
The prospective, non-interventional study sought to evaluate patient characteristics that might be predictive of pain by evaluating pre-procedure anxiety levels and sleep patterns in 140 consecutive patients scheduled for intravitreal injection by two experienced surgeons at two separate sites. Before each injection, patients filled out the Generalized Anxiety Disorder (GAD-7) questionnaire and the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Both tools used a scale from 1 to 21 to indicate increasing levels of anxiety and poor sleep quality. The mean patient age was 72 years, and the most common indication for intravitreal injection was wet age-related macular degeneration.
The mean anxiety score was 4.9, and the PSQI was 6.3. Mean reported procedure pain was mild to moderate. Anxiety was significantly correlated with procedure pain. Previous night sleep hours and PSQI were also correlated with pain but not significantly. Age, gender, laterality, previous injections and the surgeon were not predictors of pain.
“With the ability to predict which patients are at increased risk to experience pain, improved counseling as well as pain-modifying techniques can be used to target this specific patient population,” Wieder said.
Several studies have evaluated pain-modifying techniques, including anesthesia or changing the injection site. Future studies on modifications that target anxiety may help address pain perception in the procedure, he said.
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Mbekeani J, et al. Impact of anxiety levels and sleep patterns on perceived pain during intravitreal injections. Presented at: Association for Research in Vision and Ophthalmology annual meeting; June 12, 2020 (virtual meeting).
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